Timing and type of personal protective equipment adherence lapses in pediatric trauma resuscitation: A retrospective video study

Abstract

Background Although personal protective equipment (PPE) reduces the transmission of infectious diseases, adherence among health care providers remains inconsistent. Developing strategies to improve PPE use requires understanding the factors associated with adherence lapses, defined as the partial undoing or removal of PPE, leading to nonadherence. Methods We performed a retrospective video review of 10 pediatric trauma resuscitations from March 2023 to July 2024. We recorded the number of lapses, the time from adherence to lapse (time-to-lapse), and the timing of lapses during resuscitation. We observed provider actions before and after a lapse to understand situational factors. Results We observed 292 lapses among 120 providers. The median time-to-lapse was 7.7 minutes (interquartile range [IQR] 3.8-15.1) for gloves, 1.5 minutes (IQR 0.3-6.8) for masks, and 13.4 minutes (IQR 6.6-26.6) for gowns. Lapses in masks (estimate −0.4, 95% confidence interval −0.6 to −0.3, P